|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$282.72
|
|
|
Service Code
|
NDC 16729009612
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.40 |
| Max. Negotiated Rate |
$254.45 |
| Rate for Payer: Aetna American Axle |
$183.77
|
| Rate for Payer: Aetna Commercial |
$240.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.77
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Cofinity Advantage |
$197.90
|
| Rate for Payer: Cofinity Commercial |
$243.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.18
|
| Rate for Payer: Healthscope Commercial |
$254.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.04
|
| Rate for Payer: PHP Commercial |
$240.31
|
| Rate for Payer: Priority Health SBD |
$178.11
|
| Rate for Payer: UMR Bronson Commercial |
$124.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.04
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$282.72
|
|
|
Service Code
|
NDC 16729009612
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.61 |
| Max. Negotiated Rate |
$254.45 |
| Rate for Payer: Aetna American Axle |
$183.77
|
| Rate for Payer: Aetna Commercial |
$240.31
|
| Rate for Payer: Aetna Medicare |
$141.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.77
|
| Rate for Payer: BCBS Complete |
$113.09
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Cofinity Advantage |
$197.90
|
| Rate for Payer: Cofinity Commercial |
$243.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.18
|
| Rate for Payer: Healthscope Commercial |
$254.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.04
|
| Rate for Payer: PHP Commercial |
$240.31
|
| Rate for Payer: Priority Health SBD |
$178.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.77
|
| Rate for Payer: UHC Core |
$147.30
|
| Rate for Payer: UHC Exchange |
$111.11
|
| Rate for Payer: UMR Bronson Commercial |
$104.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.04
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$222.30
|
|
|
Service Code
|
NDC 68180061507
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.81 |
| Max. Negotiated Rate |
$200.07 |
| Rate for Payer: Aetna American Axle |
$144.50
|
| Rate for Payer: Aetna Commercial |
$188.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.50
|
| Rate for Payer: Cash Price |
$177.84
|
| Rate for Payer: Cofinity Advantage |
$155.61
|
| Rate for Payer: Cofinity Commercial |
$191.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.84
|
| Rate for Payer: Healthscope Commercial |
$200.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.72
|
| Rate for Payer: PHP Commercial |
$188.96
|
| Rate for Payer: Priority Health SBD |
$140.05
|
| Rate for Payer: UMR Bronson Commercial |
$97.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.72
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$4,393.38
|
|
|
Service Code
|
NDC 00310028360
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,933.09 |
| Max. Negotiated Rate |
$3,954.04 |
| Rate for Payer: Aetna American Axle |
$2,855.70
|
| Rate for Payer: Aetna Commercial |
$3,734.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,855.70
|
| Rate for Payer: Cash Price |
$3,514.70
|
| Rate for Payer: Cofinity Advantage |
$3,075.37
|
| Rate for Payer: Cofinity Commercial |
$3,778.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,514.70
|
| Rate for Payer: Healthscope Commercial |
$3,954.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,075.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,295.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,734.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,295.03
|
| Rate for Payer: PHP Commercial |
$3,734.37
|
| Rate for Payer: Priority Health SBD |
$2,767.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,933.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,295.03
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$222.30
|
|
|
Service Code
|
NDC 68180061507
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.25 |
| Max. Negotiated Rate |
$200.07 |
| Rate for Payer: Aetna American Axle |
$144.50
|
| Rate for Payer: Aetna Commercial |
$188.96
|
| Rate for Payer: Aetna Medicare |
$111.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.50
|
| Rate for Payer: BCBS Complete |
$88.92
|
| Rate for Payer: Cash Price |
$177.84
|
| Rate for Payer: Cofinity Advantage |
$155.61
|
| Rate for Payer: Cofinity Commercial |
$191.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.84
|
| Rate for Payer: Healthscope Commercial |
$200.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.72
|
| Rate for Payer: PHP Commercial |
$188.96
|
| Rate for Payer: Priority Health SBD |
$140.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.50
|
| Rate for Payer: UHC Core |
$115.82
|
| Rate for Payer: UHC Exchange |
$87.36
|
| Rate for Payer: UMR Bronson Commercial |
$82.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.72
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$467.52
|
|
|
Service Code
|
NDC 00904680461
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.71 |
| Max. Negotiated Rate |
$420.77 |
| Rate for Payer: Aetna American Axle |
$303.89
|
| Rate for Payer: Aetna Commercial |
$397.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.89
|
| Rate for Payer: Cash Price |
$374.02
|
| Rate for Payer: Cofinity Advantage |
$327.26
|
| Rate for Payer: Cofinity Commercial |
$402.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.02
|
| Rate for Payer: Healthscope Commercial |
$420.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.64
|
| Rate for Payer: PHP Commercial |
$397.39
|
| Rate for Payer: Priority Health SBD |
$294.54
|
| Rate for Payer: UMR Bronson Commercial |
$205.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.64
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$467.52
|
|
|
Service Code
|
NDC 00904680461
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.98 |
| Max. Negotiated Rate |
$420.77 |
| Rate for Payer: Aetna American Axle |
$303.89
|
| Rate for Payer: Aetna Commercial |
$397.39
|
| Rate for Payer: Aetna Medicare |
$233.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.89
|
| Rate for Payer: BCBS Complete |
$187.01
|
| Rate for Payer: Cash Price |
$374.02
|
| Rate for Payer: Cofinity Advantage |
$327.26
|
| Rate for Payer: Cofinity Commercial |
$402.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.02
|
| Rate for Payer: Healthscope Commercial |
$420.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$374.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.64
|
| Rate for Payer: PHP Commercial |
$397.39
|
| Rate for Payer: Priority Health SBD |
$294.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.89
|
| Rate for Payer: UHC Core |
$243.58
|
| Rate for Payer: UHC Exchange |
$183.74
|
| Rate for Payer: UMR Bronson Commercial |
$172.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.64
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$4,393.38
|
|
|
Service Code
|
NDC 00310028360
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,625.55 |
| Max. Negotiated Rate |
$3,954.04 |
| Rate for Payer: Aetna American Axle |
$2,855.70
|
| Rate for Payer: Aetna Commercial |
$3,734.37
|
| Rate for Payer: Aetna Medicare |
$2,196.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,855.70
|
| Rate for Payer: BCBS Complete |
$1,757.35
|
| Rate for Payer: Cash Price |
$3,514.70
|
| Rate for Payer: Cofinity Advantage |
$3,075.37
|
| Rate for Payer: Cofinity Commercial |
$3,778.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,514.70
|
| Rate for Payer: Healthscope Commercial |
$3,954.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,075.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,295.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,514.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,734.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,295.03
|
| Rate for Payer: PHP Commercial |
$3,734.37
|
| Rate for Payer: Priority Health SBD |
$2,767.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,855.70
|
| Rate for Payer: UHC Core |
$2,288.95
|
| Rate for Payer: UHC Exchange |
$1,726.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,625.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,295.03
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
NDC 00904680161
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna American Axle |
$195.00
|
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna Medicare |
$150.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.00
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Advantage |
$210.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$240.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health SBD |
$189.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.00
|
| Rate for Payer: UHC Core |
$156.30
|
| Rate for Payer: UHC Exchange |
$117.90
|
| Rate for Payer: UMR Bronson Commercial |
$111.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
NDC 00904680161
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna American Axle |
$195.00
|
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Advantage |
$210.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health SBD |
$189.00
|
| Rate for Payer: UMR Bronson Commercial |
$132.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$187.53
|
|
|
Service Code
|
NDC 68180061207
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.39 |
| Max. Negotiated Rate |
$168.78 |
| Rate for Payer: Aetna American Axle |
$121.89
|
| Rate for Payer: Aetna Commercial |
$159.40
|
| Rate for Payer: Aetna Medicare |
$93.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.89
|
| Rate for Payer: BCBS Complete |
$75.01
|
| Rate for Payer: Cash Price |
$150.02
|
| Rate for Payer: Cofinity Advantage |
$131.27
|
| Rate for Payer: Cofinity Commercial |
$161.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.02
|
| Rate for Payer: Healthscope Commercial |
$168.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.65
|
| Rate for Payer: PHP Commercial |
$159.40
|
| Rate for Payer: Priority Health SBD |
$118.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.89
|
| Rate for Payer: UHC Core |
$97.70
|
| Rate for Payer: UHC Exchange |
$73.70
|
| Rate for Payer: UMR Bronson Commercial |
$69.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.65
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$187.53
|
|
|
Service Code
|
NDC 68180061207
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.51 |
| Max. Negotiated Rate |
$168.78 |
| Rate for Payer: Aetna American Axle |
$121.89
|
| Rate for Payer: Aetna Commercial |
$159.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.89
|
| Rate for Payer: Cash Price |
$150.02
|
| Rate for Payer: Cofinity Advantage |
$131.27
|
| Rate for Payer: Cofinity Commercial |
$161.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.02
|
| Rate for Payer: Healthscope Commercial |
$168.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.65
|
| Rate for Payer: PHP Commercial |
$159.40
|
| Rate for Payer: Priority Health SBD |
$118.14
|
| Rate for Payer: UMR Bronson Commercial |
$82.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.65
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,695.42
|
|
|
Service Code
|
NDC 00310028060
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$745.98 |
| Max. Negotiated Rate |
$1,525.88 |
| Rate for Payer: Aetna American Axle |
$1,102.02
|
| Rate for Payer: Aetna Commercial |
$1,441.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,102.02
|
| Rate for Payer: Cash Price |
$1,356.34
|
| Rate for Payer: Cofinity Advantage |
$1,186.79
|
| Rate for Payer: Cofinity Commercial |
$1,458.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,356.34
|
| Rate for Payer: Healthscope Commercial |
$1,525.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,186.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,271.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,441.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,271.57
|
| Rate for Payer: PHP Commercial |
$1,441.11
|
| Rate for Payer: Priority Health SBD |
$1,068.11
|
| Rate for Payer: UMR Bronson Commercial |
$745.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,271.57
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,695.42
|
|
|
Service Code
|
NDC 00310028060
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$627.31 |
| Max. Negotiated Rate |
$1,525.88 |
| Rate for Payer: Aetna American Axle |
$1,102.02
|
| Rate for Payer: Aetna Commercial |
$1,441.11
|
| Rate for Payer: Aetna Medicare |
$847.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,102.02
|
| Rate for Payer: BCBS Complete |
$678.17
|
| Rate for Payer: Cash Price |
$1,356.34
|
| Rate for Payer: Cofinity Advantage |
$1,186.79
|
| Rate for Payer: Cofinity Commercial |
$1,458.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,356.34
|
| Rate for Payer: Healthscope Commercial |
$1,525.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,186.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,271.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,356.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,441.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,271.57
|
| Rate for Payer: PHP Commercial |
$1,441.11
|
| Rate for Payer: Priority Health SBD |
$1,068.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,102.02
|
| Rate for Payer: UHC Core |
$883.31
|
| Rate for Payer: UHC Exchange |
$666.30
|
| Rate for Payer: UMR Bronson Commercial |
$627.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,271.57
|
|
|
QUINIDINE GLUCONATE ER 324 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$1,653.53
|
|
|
Service Code
|
NDC 53489014101
|
| Hospital Charge Code |
12197
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$727.55 |
| Max. Negotiated Rate |
$1,488.18 |
| Rate for Payer: Aetna American Axle |
$1,074.79
|
| Rate for Payer: Aetna Commercial |
$1,405.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,074.79
|
| Rate for Payer: Cash Price |
$1,322.82
|
| Rate for Payer: Cofinity Advantage |
$1,157.47
|
| Rate for Payer: Cofinity Commercial |
$1,422.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,322.82
|
| Rate for Payer: Healthscope Commercial |
$1,488.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,157.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,240.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,405.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,240.15
|
| Rate for Payer: PHP Commercial |
$1,405.50
|
| Rate for Payer: Priority Health SBD |
$1,041.72
|
| Rate for Payer: UMR Bronson Commercial |
$727.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,240.15
|
|
|
QUINIDINE GLUCONATE ER 324 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$1,653.53
|
|
|
Service Code
|
NDC 53489014101
|
| Hospital Charge Code |
12197
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$611.81 |
| Max. Negotiated Rate |
$1,488.18 |
| Rate for Payer: Aetna American Axle |
$1,074.79
|
| Rate for Payer: Aetna Commercial |
$1,405.50
|
| Rate for Payer: Aetna Medicare |
$826.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,074.79
|
| Rate for Payer: BCBS Complete |
$661.41
|
| Rate for Payer: Cash Price |
$1,322.82
|
| Rate for Payer: Cofinity Advantage |
$1,157.47
|
| Rate for Payer: Cofinity Commercial |
$1,422.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,322.82
|
| Rate for Payer: Healthscope Commercial |
$1,488.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,157.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,240.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,322.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,405.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,240.15
|
| Rate for Payer: PHP Commercial |
$1,405.50
|
| Rate for Payer: Priority Health SBD |
$1,041.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,074.79
|
| Rate for Payer: UHC Core |
$861.49
|
| Rate for Payer: UHC Exchange |
$649.84
|
| Rate for Payer: UMR Bronson Commercial |
$611.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,240.15
|
|
|
QUINIDINE SULFATE 200 MG TABLET
|
Facility
|
OP
|
$1,245.98
|
|
|
Service Code
|
NDC 42806051330
|
| Hospital Charge Code |
6777
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$461.01 |
| Max. Negotiated Rate |
$1,121.38 |
| Rate for Payer: Aetna American Axle |
$809.89
|
| Rate for Payer: Aetna Commercial |
$1,059.08
|
| Rate for Payer: Aetna Medicare |
$622.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$809.89
|
| Rate for Payer: BCBS Complete |
$498.39
|
| Rate for Payer: Cash Price |
$996.78
|
| Rate for Payer: Cofinity Advantage |
$872.19
|
| Rate for Payer: Cofinity Commercial |
$1,071.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$996.78
|
| Rate for Payer: Healthscope Commercial |
$1,121.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$872.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$934.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$996.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,059.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$934.49
|
| Rate for Payer: PHP Commercial |
$1,059.08
|
| Rate for Payer: Priority Health SBD |
$784.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$809.89
|
| Rate for Payer: UHC Core |
$649.16
|
| Rate for Payer: UHC Exchange |
$489.67
|
| Rate for Payer: UMR Bronson Commercial |
$461.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$934.49
|
|
|
QUINIDINE SULFATE 200 MG TABLET
|
Facility
|
IP
|
$1,245.98
|
|
|
Service Code
|
NDC 42806051330
|
| Hospital Charge Code |
6777
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$548.23 |
| Max. Negotiated Rate |
$1,121.38 |
| Rate for Payer: Aetna American Axle |
$809.89
|
| Rate for Payer: Aetna Commercial |
$1,059.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$809.89
|
| Rate for Payer: Cash Price |
$996.78
|
| Rate for Payer: Cofinity Advantage |
$872.19
|
| Rate for Payer: Cofinity Commercial |
$1,071.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$996.78
|
| Rate for Payer: Healthscope Commercial |
$1,121.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$872.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$934.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,059.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$934.49
|
| Rate for Payer: PHP Commercial |
$1,059.08
|
| Rate for Payer: Priority Health SBD |
$784.97
|
| Rate for Payer: UMR Bronson Commercial |
$548.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$934.49
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$2,850.96
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
186395
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,254.42 |
| Max. Negotiated Rate |
$2,565.86 |
| Rate for Payer: Aetna American Axle |
$1,853.12
|
| Rate for Payer: Aetna Commercial |
$2,423.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,853.12
|
| Rate for Payer: Cash Price |
$2,280.77
|
| Rate for Payer: Cofinity Advantage |
$1,995.67
|
| Rate for Payer: Cofinity Commercial |
$2,451.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,280.77
|
| Rate for Payer: Healthscope Commercial |
$2,565.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,995.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,138.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,423.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,138.22
|
| Rate for Payer: PHP Commercial |
$2,423.32
|
| Rate for Payer: Priority Health SBD |
$1,796.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,254.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,138.22
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$2,850.96
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
186395
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$143.92 |
| Max. Negotiated Rate |
$2,565.86 |
| Rate for Payer: Aetna American Axle |
$1,853.12
|
| Rate for Payer: Aetna American Axle |
$5,559.37
|
| Rate for Payer: Aetna American Axle |
$2,088.97
|
| Rate for Payer: Aetna American Axle |
$9,265.61
|
| Rate for Payer: Aetna Commercial |
$12,116.56
|
| Rate for Payer: Aetna Commercial |
$2,423.32
|
| Rate for Payer: Aetna Commercial |
$7,269.95
|
| Rate for Payer: Aetna Commercial |
$2,731.73
|
| Rate for Payer: Aetna Medicare |
$286.19
|
| Rate for Payer: Aetna Medicare |
$286.19
|
| Rate for Payer: Aetna Medicare |
$286.19
|
| Rate for Payer: Aetna Medicare |
$286.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,559.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,265.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,853.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,088.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$343.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$343.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$343.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$343.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$343.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$343.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$343.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$343.98
|
| Rate for Payer: BCBS Complete |
$151.13
|
| Rate for Payer: BCBS Complete |
$151.13
|
| Rate for Payer: BCBS Complete |
$151.13
|
| Rate for Payer: BCBS Complete |
$151.13
|
| Rate for Payer: BCBS MAPPO |
$275.18
|
| Rate for Payer: BCBS MAPPO |
$275.18
|
| Rate for Payer: BCBS MAPPO |
$275.18
|
| Rate for Payer: BCBS MAPPO |
$275.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,104.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,104.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,104.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,104.55
|
| Rate for Payer: BCN Commercial |
$1,104.55
|
| Rate for Payer: BCN Commercial |
$1,104.55
|
| Rate for Payer: BCN Commercial |
$1,104.55
|
| Rate for Payer: BCN Commercial |
$1,104.55
|
| Rate for Payer: BCN Medicare Advantage |
$275.18
|
| Rate for Payer: BCN Medicare Advantage |
$275.18
|
| Rate for Payer: BCN Medicare Advantage |
$275.18
|
| Rate for Payer: BCN Medicare Advantage |
$275.18
|
| Rate for Payer: Cash Price |
$6,842.30
|
| Rate for Payer: Cash Price |
$6,842.30
|
| Rate for Payer: Cash Price |
$2,571.04
|
| Rate for Payer: Cash Price |
$2,280.77
|
| Rate for Payer: Cash Price |
$11,403.82
|
| Rate for Payer: Cash Price |
$2,280.77
|
| Rate for Payer: Cash Price |
$11,403.82
|
| Rate for Payer: Cash Price |
$2,571.04
|
| Rate for Payer: Cofinity Advantage |
$9,978.35
|
| Rate for Payer: Cofinity Advantage |
$5,987.02
|
| Rate for Payer: Cofinity Advantage |
$1,995.67
|
| Rate for Payer: Cofinity Advantage |
$2,249.66
|
| Rate for Payer: Cofinity Commercial |
$2,451.83
|
| Rate for Payer: Cofinity Commercial |
$7,355.48
|
| Rate for Payer: Cofinity Commercial |
$2,763.87
|
| Rate for Payer: Cofinity Commercial |
$12,259.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,403.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,571.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,280.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,842.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.18
|
| Rate for Payer: Healthscope Commercial |
$2,892.42
|
| Rate for Payer: Healthscope Commercial |
$12,829.30
|
| Rate for Payer: Healthscope Commercial |
$2,565.86
|
| Rate for Payer: Healthscope Commercial |
$7,697.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,249.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,978.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,987.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,995.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,138.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,414.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,410.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,691.08
|
| Rate for Payer: Mclaren Medicaid |
$275.18
|
| Rate for Payer: Mclaren Medicaid |
$275.18
|
| Rate for Payer: Mclaren Medicaid |
$275.18
|
| Rate for Payer: Mclaren Medicaid |
$275.18
|
| Rate for Payer: Mclaren Medicare |
$275.18
|
| Rate for Payer: Mclaren Medicare |
$275.18
|
| Rate for Payer: Mclaren Medicare |
$275.18
|
| Rate for Payer: Mclaren Medicare |
$275.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$288.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$288.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$288.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$288.94
|
| Rate for Payer: Meridian Medicaid |
$288.94
|
| Rate for Payer: Meridian Medicaid |
$288.94
|
| Rate for Payer: Meridian Medicaid |
$288.94
|
| Rate for Payer: Meridian Medicaid |
$288.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$316.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$316.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$316.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$316.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$302.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$302.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$302.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$302.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,423.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,731.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,269.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,116.56
|
| Rate for Payer: Nomi Health Commercial |
$825.54
|
| Rate for Payer: Nomi Health Commercial |
$825.54
|
| Rate for Payer: Nomi Health Commercial |
$825.54
|
| Rate for Payer: Nomi Health Commercial |
$825.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,138.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,691.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,410.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,414.66
|
| Rate for Payer: PACE Medicare |
$261.42
|
| Rate for Payer: PACE Medicare |
$261.42
|
| Rate for Payer: PACE Medicare |
$261.42
|
| Rate for Payer: PACE Medicare |
$261.42
|
| Rate for Payer: PACE SWMI |
$275.18
|
| Rate for Payer: PACE SWMI |
$275.18
|
| Rate for Payer: PACE SWMI |
$275.18
|
| Rate for Payer: PACE SWMI |
$275.18
|
| Rate for Payer: PHP Commercial |
$2,731.73
|
| Rate for Payer: PHP Commercial |
$2,423.32
|
| Rate for Payer: PHP Commercial |
$12,116.56
|
| Rate for Payer: PHP Commercial |
$7,269.95
|
| Rate for Payer: PHP Medicare Advantage |
$275.18
|
| Rate for Payer: PHP Medicare Advantage |
$275.18
|
| Rate for Payer: PHP Medicare Advantage |
$275.18
|
| Rate for Payer: PHP Medicare Advantage |
$275.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$882.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$882.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$882.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$882.66
|
| Rate for Payer: Priority Health Medicare |
$275.18
|
| Rate for Payer: Priority Health Medicare |
$275.18
|
| Rate for Payer: Priority Health Medicare |
$275.18
|
| Rate for Payer: Priority Health Medicare |
$275.18
|
| Rate for Payer: Priority Health SBD |
$5,388.31
|
| Rate for Payer: Priority Health SBD |
$8,980.51
|
| Rate for Payer: Priority Health SBD |
$2,024.69
|
| Rate for Payer: Priority Health SBD |
$1,796.10
|
| Rate for Payer: Priority Health Tiered Network |
$706.13
|
| Rate for Payer: Priority Health Tiered Network |
$706.13
|
| Rate for Payer: Priority Health Tiered Network |
$706.13
|
| Rate for Payer: Priority Health Tiered Network |
$706.13
|
| Rate for Payer: Railroad Medicare Medicare |
$275.18
|
| Rate for Payer: Railroad Medicare Medicare |
$275.18
|
| Rate for Payer: Railroad Medicare Medicare |
$275.18
|
| Rate for Payer: Railroad Medicare Medicare |
$275.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.92
|
| Rate for Payer: UHC Core |
$461.92
|
| Rate for Payer: UHC Core |
$461.92
|
| Rate for Payer: UHC Core |
$461.92
|
| Rate for Payer: UHC Core |
$461.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$275.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$275.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$275.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$275.18
|
| Rate for Payer: UHC Exchange |
$461.92
|
| Rate for Payer: UHC Exchange |
$461.92
|
| Rate for Payer: UHC Exchange |
$461.92
|
| Rate for Payer: UHC Exchange |
$461.92
|
| Rate for Payer: UHC Medicaid |
$143.92
|
| Rate for Payer: UHC Medicaid |
$143.92
|
| Rate for Payer: UHC Medicaid |
$143.92
|
| Rate for Payer: UHC Medicaid |
$143.92
|
| Rate for Payer: UHCCP Medicaid |
$143.92
|
| Rate for Payer: UHCCP Medicaid |
$143.92
|
| Rate for Payer: UHCCP Medicaid |
$143.92
|
| Rate for Payer: UHCCP Medicaid |
$143.92
|
| Rate for Payer: UMR Bronson Commercial |
$1,189.11
|
| Rate for Payer: UMR Bronson Commercial |
$1,054.86
|
| Rate for Payer: UMR Bronson Commercial |
$5,274.27
|
| Rate for Payer: UMR Bronson Commercial |
$3,164.57
|
| Rate for Payer: VA VA |
$275.18
|
| Rate for Payer: VA VA |
$275.18
|
| Rate for Payer: VA VA |
$275.18
|
| Rate for Payer: VA VA |
$275.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,410.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,414.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,138.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,691.08
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP
|
Facility
|
IP
|
$1,890.12
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
22120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$831.65 |
| Max. Negotiated Rate |
$1,701.11 |
| Rate for Payer: Aetna American Axle |
$1,228.58
|
| Rate for Payer: Aetna Commercial |
$1,606.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,228.58
|
| Rate for Payer: Cash Price |
$1,512.10
|
| Rate for Payer: Cofinity Advantage |
$1,323.08
|
| Rate for Payer: Cofinity Commercial |
$1,625.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,512.10
|
| Rate for Payer: Healthscope Commercial |
$1,701.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,323.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,417.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,606.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,417.59
|
| Rate for Payer: PHP Commercial |
$1,606.60
|
| Rate for Payer: Priority Health SBD |
$1,190.78
|
| Rate for Payer: UMR Bronson Commercial |
$831.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,417.59
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP
|
Facility
|
OP
|
$1,890.12
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
22120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$164.86 |
| Max. Negotiated Rate |
$1,701.11 |
| Rate for Payer: Aetna American Axle |
$1,228.58
|
| Rate for Payer: Aetna Commercial |
$1,606.60
|
| Rate for Payer: Aetna Medicare |
$327.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,228.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$394.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$394.02
|
| Rate for Payer: BCBS Complete |
$173.12
|
| Rate for Payer: BCBS MAPPO |
$315.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,383.19
|
| Rate for Payer: BCN Commercial |
$1,383.19
|
| Rate for Payer: BCN Medicare Advantage |
$315.22
|
| Rate for Payer: Cash Price |
$1,512.10
|
| Rate for Payer: Cash Price |
$1,512.10
|
| Rate for Payer: Cofinity Advantage |
$1,323.08
|
| Rate for Payer: Cofinity Commercial |
$1,625.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,512.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$315.22
|
| Rate for Payer: Healthscope Commercial |
$1,701.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,323.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,417.59
|
| Rate for Payer: Mclaren Medicaid |
$315.22
|
| Rate for Payer: Mclaren Medicare |
$315.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$330.98
|
| Rate for Payer: Meridian Medicaid |
$330.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$362.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$346.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,606.60
|
| Rate for Payer: Nomi Health Commercial |
$945.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,417.59
|
| Rate for Payer: PACE Medicare |
$299.46
|
| Rate for Payer: PACE SWMI |
$315.22
|
| Rate for Payer: PHP Commercial |
$1,606.60
|
| Rate for Payer: PHP Medicare Advantage |
$315.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$989.34
|
| Rate for Payer: Priority Health Medicare |
$315.22
|
| Rate for Payer: Priority Health SBD |
$1,190.78
|
| Rate for Payer: Priority Health Tiered Network |
$791.47
|
| Rate for Payer: Railroad Medicare Medicare |
$315.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$527.59
|
| Rate for Payer: UHC Core |
$527.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$315.22
|
| Rate for Payer: UHC Exchange |
$527.59
|
| Rate for Payer: UHC Medicaid |
$164.86
|
| Rate for Payer: UHCCP Medicaid |
$164.86
|
| Rate for Payer: UMR Bronson Commercial |
$699.34
|
| Rate for Payer: VA VA |
$315.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,417.59
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$6.69
|
|
|
Service Code
|
NDC 00487590199
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: Aetna American Axle |
$4.35
|
| Rate for Payer: Aetna Commercial |
$5.69
|
| Rate for Payer: Aetna Medicare |
$3.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.35
|
| Rate for Payer: BCBS Complete |
$2.68
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cofinity Advantage |
$4.68
|
| Rate for Payer: Cofinity Commercial |
$5.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.35
|
| Rate for Payer: Healthscope Commercial |
$6.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.02
|
| Rate for Payer: PHP Commercial |
$5.69
|
| Rate for Payer: Priority Health SBD |
$4.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.35
|
| Rate for Payer: UHC Core |
$3.49
|
| Rate for Payer: UHC Exchange |
$2.63
|
| Rate for Payer: UMR Bronson Commercial |
$2.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.02
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$3.72
|
|
|
Service Code
|
NDC 00487278401
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna American Axle |
$2.42
|
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: Aetna Medicare |
$1.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.42
|
| Rate for Payer: BCBS Complete |
$1.49
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Advantage |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$3.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$3.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.79
|
| Rate for Payer: PHP Commercial |
$3.16
|
| Rate for Payer: Priority Health SBD |
$2.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.42
|
| Rate for Payer: UHC Core |
$1.94
|
| Rate for Payer: UHC Exchange |
$1.46
|
| Rate for Payer: UMR Bronson Commercial |
$1.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.79
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$6.69
|
|
|
Service Code
|
NDC 00487590199
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: Aetna American Axle |
$4.35
|
| Rate for Payer: Aetna Commercial |
$5.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.35
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cofinity Advantage |
$4.68
|
| Rate for Payer: Cofinity Commercial |
$5.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.35
|
| Rate for Payer: Healthscope Commercial |
$6.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.02
|
| Rate for Payer: PHP Commercial |
$5.69
|
| Rate for Payer: Priority Health SBD |
$4.21
|
| Rate for Payer: UMR Bronson Commercial |
$2.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.02
|
|
